As federal and state policymakers make decisions that will reshape Medicaid for years to come, the stakes for direct care workers and the people they support have never been higher. This brief — the first in PHI’s three-part midterm policy series — examines how cuts enacted through the 2025 budget reconciliation act (HR 1) are threatening access to long-term services and supports, destabilizing the direct care workforce, and undermining the health coverage that millions of workers rely on for themselves and their families.
Restore Medicaid assesses the changing Medicaid landscape and proposes critical actions for policymakers at the federal and state levels changing Medicaid landscape and sets out concrete recommendations for policymakers at the federal and state levels — from protecting HCBS funding and minimizing harmful enrollment barriers to investing in a national direct care workforce strategy.
Key Takeaways
HR 1 harms direct care workers both as providers of Medicaid-funded services and as Medicaid enrollees themselves — threatening their wages, job stability, and personal health coverage.
With federal funding reduced, states are cutting provider rates, limiting HCBS benefits, and adding enrollment hurdles — with home and community-based services especially vulnerable.
Policymakers must restore and strengthen Medicaid funding, minimize burdensome eligibility requirements, and invest in a national direct care workforce strategy to meet growing care needs.
